Quality statement 6	Review, reassessment and withdrawal: (a) All patients started on LTOT should be followed up with blood gas assessment within 3 months of initiation of therapy; this includes those patients who are discharged home from hospital on LTOT for the first time. (b) All patients who continue on LTOT should be monitored at least on an annual basis by a home oxygen assessment service. (c) All patients who are identified as no longer requiring any form of home oxygen should have this withdrawn.
Rationale	The patient’s clinical status can vary with time, and a repeat assessment that the indication for LTOT is still present and that use is appropriate and well tolerated is required. Home oxygen assessment services require a robust identification and recall system for patients started on LTOT, which includes patients discharged home from hospital with a new LTOT order. Where home oxygen is no longer indicated, it should be withdrawn in a carefully planned systematic way including all relevant agencies. Where there are significant concerns about emergent risk, the provision of home oxygen should be reassessed by the home oxygen team, ensuring there is multidisciplinary input (eg, general practitioner, social worker, community matron, and so on). To ensure that appropriate risk assessments are carried out once LTOT is in use, risk assessments require review within 3 months and at each annual review.
Quality measure	Structure: Evidence that the local home oxygen assessment service reviews patients on LTOT via a face-to-face visit within 3 months of initiation. Evidence that the local home oxygen assessment service reviews patients on LTOT via a face-to-face visit annually. Evidence that patients who after reassessment no longer meet indication for LTOT have it withdrawn. Evidence that risk reassessments are completed at all reviews. Process: The proportion of patients on LTOT who are reassessed within 3 months of initiation of LTOT. The proportion of patients on LTOT who complete a yearly follow-up assessment of LTOT. The proportion of patients who no longer meet indication for LTOT who have LTOT withdrawn. The proportion of patients who have risk reassessments completed at each review. Numerator 1: The number of patients reassessed face to face within 3 months of initiation of LTOT. Denominator 1: The number of patients started on LTOT. Numerator 2: The number of patients on LTOT reassessed face-to-face annually. Denominator 2: The number of patients on LTOT.
	Numerator 3: The number of patients with LTOT withdrawn after reassessment. Denominator 3: The number of patients who no longer meet criteria at reassessment for LTOT. Numerator 4: The number of patients who have a risk assessment updated at review. Denominator 4: The number of patients on LTOT.
Description of what the quality statement means for each audience	Service providers: It is necessary to create a robust system of identifying patients started on LTOT and timely recall for reassessment. Implementation of reporting systems to demonstrate that quality measures are being achieved. Implementation of risk assessment process and escalation process in case of failed risk assessment. Healthcare professionals: Ensure all patients have an LTOT reassessment within 3 months of initiation of LTOT. Ensure LTOT is withdrawn promptly where it is no longer indicated after hospital-discharge initiation. Complete risk assessment at every reassessment and escalate where necessary. Commissioners: Ensure that there are appropriate resources and trained staff to follow up and reassess patients commenced on LTOT.
	People who require home oxygen: Should understand the importance of an oxygen reassessment, the appropriateness of withdrawal where indicated and the need for risk assessments and escalation where necessary.
Relevant existing indicators/data sources	Home oxygen assessment service register.
Source references	BTS Guideline for Home Oxygen Use in Adults June 2015.3 BTS Guidelines for Oxygen Use in Adults in Healthcare and Emergency Settings 2017.8 NICE Guidelines on Management of Cluster Headache 2012.9